Nephrology

Nephrology is a medical discipline that covers the diagnosis, treatment and management of kidney diseases. Commonly treated disorders include kidney stones and kidney failure. Nephrology also involves comprehensive care for kidney diseases associated with other illnesses and conditions, such as hypertension and diabetes.

Kidney Transplant

The Centres of Nephrology and Urology have a sizeable and comprehensive kidney transplant program, having performed both autologous and cadaveric transplants. It has the first organ transplant registry in India. The Centres also perform minimally invasive surgery for renal donors thereby minimising post-operative recovery time and hospitalisation.

The stringent infection control practices, immunosuppressive protocols and proactive vigil for complications and their prompt management make the service a huge success. The Transplant unit also integrates, analyzes and addresses the health needs of the transplant patient and his or her family. The Apollo Hospitals group has performed more than 21000 kidney transplants till date.

Types of kidney transplants performed

Cadaveric renal transplantation

Cadaver-donor kidney transplantation

Living donor kidney transplants (from both related and unrelated donors)

Laparoscopic donor Nephrectomy

What is a kidney transplant?

A kidney transplant is a surgical procedure to place a kidney from a live or deceased donor into a person whose kidneys no longer function properly.

The kidneys remove excess fluid and waste from blood. When kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate resulting in kidney failure or end-stage kidney disease. A kidney transplant is often the best treatment for kidney failure.

Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option. If a compatible living donor isn’t available for a kidney transplant, the patient’s name may be placed on a kidney transplant waiting list to receive a kidney from a deceased donor.

A kidney transplant is used to treat kidney failure (end-stage kidney disease), a condition in which kidneys can function at only a fraction of normal capacity. People with end-stage kidney disease need either to have waste removed from their bloodstream (dialysis) or a kidney transplant to stay alive.

Causes of kidney failure

Diabetes

Chronic, uncontrolled high blood pressure

Chronic glomerulonephritis – an inflammation and eventual scarring of the tiny filters within your kidneys (glomeruli)

Polycystic kidney disease

Sometimes kidney disease can be managed with diet, medication and treatment for the underlying cause. If despite these steps kidneys still can’t filter your blood adequately,r a kidney transplant is the treatment of choice.

Finding a donor

A kidney donor can be living or deceased, related or unrelated. The nephrologist will consider several factors, such as blood and tissue types, when evaluating whether a living donor will be a good match. Family members are often the most likely to be compatible kidney donors. But many people undergo successful transplants with kidneys donated from people who are not related to them.

During a kidney transplant

Kidney transplants are performed with general anesthesia

The surgeon makes an incision and places the new kidney in the lower abdomen. Unless the patient’s own kidneys are causing complications such as high blood pressure, kidney stones, pain or infection, they are left in place.

The blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen, just above one of the legs.

The new kidney’s ureter – the tube that links the kidney to the bladder – is connected to the bladder.

After a kidney transplant

Doctors and nurses monitor the patient’s condition in the hospital’s transplant recovery area to watch for signs of complications. The new kidney will make urine like the patient’s own kidneys did when they were healthy. Often this starts immediately. In other cases it takes several days.

Close monitoring is necessary for a few weeks.

Transplant recipients need a number of medications after kidney transplant. Drugs called immunosuppressant’s help keep the patient’s own immune system from attacking the new kidney. Additional drugs help reduce the risk of other complications, such as infection, after transplant.

Dialysis

Dialysis is a treatment where the functions of the kidney are replicated by the dialysis process in situations where the kidneys have failed to function normally.

When is dialysis needed?

Dialysis is needed when you develop end stage kidney failure – usually when 85 to 90 percent of your kidney function is lost and there is a GFR of < 15.

What does dialysis do?

Dialysis is required to keep the body in balance by:

waste, salt and extra water removal to prevent them from building up in the body

ensuring maintenance of a safe level of chemicals in your blood, like potassium, sodium and bicarbonate

blood pressure control

Is kidney failure permanent?

In some cases, acute kidney failure can get better after treatment. In such cases of acute kidney failure, dialysis is done only for a short time until the kidneys get better.

In chronic or end stage kidney failure, your kidneys do not get better and you will need dialysis for the rest of your life unless transplant is an option.

Are there different types of dialysis?

Hemodialysis and peritoneal dialysis are the two types of dialysis

Will dialysis help cure the kidney disease?

No. Dialysis does the work of healthy kidneys, but it does not cure the kidney disease.

Is dialysis uncomfortable?

The dialysis treatment is painless. However, some patients may have fall in BP, nausea, vomiting, headache or cramps. With frequent treatments, those problems usually go away.

Do dialysis patients feel normal?

Many patients live normal lives except for the time needed for treatments. Dialysis usually makes you feel better because it helps many of the problems caused by kidney failure.

Do dialysis patients have to control their diets?

Yes. You may be on a special diet. The diet may vary according to the type of dialysis.

Can dialysis patients continue to work?

Many dialysis patients can go back to work after they have gotten used to dialysis.

Hemodialysis

In hemodialysis, waste and extra chemicals and fluid from your blood are removed by a hemodialyser machine. To get your blood into the machine, an access is made into your blood vessels. This is done by minor surgery to your arm or leg. Sometimes, joining an artery to a vein under your skin to make a bigger blood vessel called a fistula is also done.

How long do hemodialysis treatments last?

This depends on:

how good kidney function is

fluid weight gained between treatments

build and weight of patient

the type of dialyzer used

Usually, each hemodialysis treatment lasts about four hours and is done three times per week.

Peritoneal dialysis

In this type of dialysis, your blood is cleaned within your body. A plastic tube called a catheter is placed into your abdomen to make an access. During the treatment, the peritoneal cavity in the abdominal area is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate. Plasma exchange may be done along with dialysis, to filter clotting factors and unwanted proteins. Charcoal hemofiltration in which a charcoal layer is used to remove wastes from blood, a process similar to dialysis, may sometimes be used.

What are the different kinds of peritoneal dialysis and how do they work?

Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD) are the two common types.

Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. The patient can do it themselves usually four or five times a day at home or work. A bag of dialysate needs to be put into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange.

Automated Peritoneal Dialysis (APD) is done using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night while you sleep.